Self-Adjusting File: SAF

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Self-Adjusting File: SAF

  1. 2. A New Paradigm in NiTi Instrumentation Raviv Zary
  2. 3. Paradigm “ A framework of thoughts and concepts within which scientific experiments are performed”
  3. 4. The Introduction of Nickel-Titanium Rotary Instruments Represented a Paradigm Shift in Endodontics
  4. 5. Profile 1993 A Disruptive Technology
  5. 6. Evolution of Rotary NiTi Files <ul><li>Profile 1993 </li></ul><ul><li>Quantec 1996 </li></ul><ul><li>GT 1998 </li></ul><ul><li>Hero642 1999 </li></ul><ul><li>FlexMaster 2000 </li></ul>1 st Generation Symmetrical & Uniform
  6. 7. Evolution of Rotary NiTi Files <ul><li>Race 1999 </li></ul><ul><li>ProTaper 2001 </li></ul><ul><li>K3 2001 </li></ul><ul><li>Hero Shaper 2002 </li></ul><ul><li>Revo-S 2009 </li></ul>2nd Generation Asymmetrical and/or Not Uniform
  7. 8. Evolution of Rotary NiTi Files 3rd Generation <ul><li>GT - X 2009 M Wire </li></ul><ul><li>TF 2009 R Phase </li></ul>Innovative Metallurgy
  8. 9. <ul><li>Motorized instrumentation </li></ul><ul><li>Faster instrumentation </li></ul><ul><li>Able to negotiate </li></ul><ul><li>curved canals </li></ul>Great Technology !
  9. 10. Nevertheless Rotaries are Rotaries are Rotaries …
  10. 11. Common to all : <ul><li>Many instruments </li></ul><ul><li>Complicated sequences </li></ul><ul><li>Tedious </li></ul><ul><li>repeated rinsing </li></ul><ul><li>is essential </li></ul>
  11. 12. Common to all : <ul><li>Instruments break </li></ul><ul><li>unexpectedly </li></ul><ul><li>Separated apical part </li></ul><ul><li>is difficult to remove </li></ul>A Major Drawback !
  12. 13. Common to all : Ignoring the 3D shape of the root canals !
  13. 14. The Common Misconception Dentists tend to relate to all root canals as if they had a uniform round cross section
  14. 15. This is true in upper incisors but wrong in many other teeth
  15. 16. Oval or flat canals are common in lower incisors canines premolars distal roots of lower molars
  16. 18. Canals with “ tear-shaped” cross section are common in premolars mesial roots of lower molars mesio-buccal roots of upper molars
  17. 19. All appear the same on a 2D X-ray
  18. 20. Current High-End Technology Rotating Blade with Flutes
  19. 21. All root canals are machined to a round cross section
  20. 22. Root Canals with a Tear-Shaped Cross-Section
  21. 23. Treated with Rotary Nickel Titanium Files Flat Canals * * Will look great on the radiograph
  22. 24. Treated with Rotary Nickel Titanium Files Canals with a “ Tear-Shaped” Cross Section * * Will look great on the radiograph
  23. 25. Do We Aim for Nice Radiographs or High Quality Endodontic Treatment ?
  24. 26. This may explain the frequently encountered enigma : Endodontic failures in roots with apparently good root canal fillings * * Misleading 2D X-Ray images
  25. 27. Wu & Wesselink, Int Endod J 34: 137-141, 2001
  26. 28. De Deus et al. Int Endod J 41: 183-190, 2008
  27. 29. De Deus et al. J Endod 34: 1401-1405, 2008
  28. 30. Micro CT Analysis B12 Rotary File
  29. 31. Bucco-Lingual B12 Rotary File Mesio-Distal
  30. 32. B12 Rotary File 2 mm 4 mm 6 mm
  31. 33. B53 Rotary File Micro CT Analysis Bucco-Lingual Mesio-Distal
  32. 34. 2 mm B53 Rotary File 2 mm 4 mm 6 mm
  33. 35. J Endod 35: 1044-1047, 2009 Hard Tissue Debris Accumulation Analysis by High Resolution Computed Tomography Scans Paqué et al 2009 New Insight !
  34. 36. Packing of Debris into the Isthmus Area During Rotary Instrumentation
  35. 37. The Longitudinal 3D challenge Curved Canals
  36. 38. Int Endod J 36: 86-92, 2003 ProTaper Rotary Root Canal Preparation: Effects of Canal Anatomy on Final Shape Analyzed by Micro CT Peters et al 2003 3 D X-Ray
  37. 39. Peters et al 2003 Superimposed Images Red : Surface untouched by file Green : Affected surface Clear : Final preparation
  38. 40. Percent of Root Canal Surface Unchanged by the File Int Endod J 36: 86-92, 2003 Peters et al 2003 Disto-buccal (n=11) 33 (±19)% Mesio-buccal (n=11) 43 (±29)% Palatal (n=11) 49 (±29)%
  39. 41. Paqué et al 2009 ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal Surface Adapted from: Paqué et al J Endod 35:1056-9, 2009 Can we do Better ?
  40. 42. Peters et al. Int Endod J 2003, 36:86-92 Canal Transportation* (µm) & Canal Straightening (%) in Upper Molars * CM shift
  41. 43. (2) Peters et al. Int Endod J 2003, 36:86-92 Canal Transportation* (µm) P MB DB * CM shift Can we do better ?
  42. 44. (2) Peters et al, Int Endod J 2003, 36:86-92 Canal Straightening (%) P MB DB Can we do better ?
  43. 45. NiTi Rotary Files Resulted in a Great Progress in Endodontics
  44. 46. Which Frontiers Still Remain to be Engaged ?
  45. 47. <ul><li>Many instruments </li></ul><ul><li>Complicated </li></ul><ul><li>Sequences </li></ul>
  46. 48. <ul><li>Unexpected </li></ul><ul><li>instrument </li></ul><ul><li>separation </li></ul>
  47. 49. <ul><li>Flat oval root canals </li></ul><ul><li>Canal transportation </li></ul><ul><li>Curved root canals </li></ul>
  48. 50. <ul><li>Need for </li></ul><ul><li>effective irrigation </li></ul>
  49. 51. These Call for Out-of-the-Box Thinking
  50. 52. Paradigm Shift in Canal Instrumentation
  51. 53. A New Concept SAF System
  52. 54. A Self Adjusting File SAF System Operated by a Vibrating Handpiece Made of NiTi
  53. 55. The hollow file is used with continuous irrigation
  54. 56. Cleaning & Shaping and Irrigation are Achieved Simultaneously
  55. 57. SAF System A New Concept A Compressible File 1
  56. 58. A hollow, compressible file
  57. 59. SAF Adapted into a # 20 K File Path
  58. 60. SAF System A New Concept A File Which Adapts Itself to the Canal’s 3D Anatomy 2
  59. 61. Adaptation to Longitudinal Curvature
  60. 62. Mandibular Incisor Adaptation to Oval Cross Section
  61. 63. SAF System Circumferential Removal of Dentin 3 A New Concept
  62. 64. Sand Paper <ul><li>Rough Surface </li></ul><ul><li>Pressure </li></ul><ul><li>Repeated Motion </li></ul>
  63. 65. Roughness : 2.8 µm ± 10%
  64. 66. The vibrating hand-piece provides 5000 vibrations per min + Pecking Motion
  65. 67. Goal attained with a minimal and uniform wall thickness reduction !
  66. 68. SAF Current Nickel Titanium Rotary Files Flat Canals
  67. 69. Current Nickel Titanium Rotary Files SAF Canals with a “ Tear-Shaped ” Cross Section
  68. 70. Micro CT Analysis Red : before treatment Blue over red : after 4 min treatment G93
  69. 71. Micro CT Analysis Red : before treatment Blue over red : after 4 min treatment A 32
  70. 72. Cross section at 6 mm from the apex A 32
  71. 73. <ul><li>An Extreme Case </li></ul><ul><li>C-Shaped Canal </li></ul>
  72. 74. 2 nd Lower Molar TLS 16
  73. 75. 0° - 45° - 180° 90° 45° TLS 16 1 mm
  74. 76. SAF preparation 0° - 40° - 120° - 80° 120° 80° 40° Green: before preparation Red: after preparation 1 mm
  75. 77. Cross Sections 4mm 2mm Distance from the apex
  76. 78. Distal Roots of Lower Molars Paqué et al J Endod 36:703-707, 2010 ProTaper – Manufacturer’s Instructions 79.9 (±10.3)% Untreated
  77. 79. Distal Roots of Lower Molars ProTaper Circumferential Filing 69.1 (±9.2)% Untreated Paqué et al J Endod 36:703-707, 2010
  78. 80. Distal Roots of Lower Molars SAF System 23.5 ( ± 8.9)% Untreated
  79. 81. SAF System Prevention of Canal Transportation 4 A New Concept
  80. 82. Micro CT Analysis A 22
  81. 83. Paqué et al 2009 SAF Current Study ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal Surface Adapted from: Paqué et al J Endod 35:1056-9, 2009
  82. 84. (1) (2) (1) Peters et al, Int Endod J 2003, 36:86-92 (2) Metzger et al, on-going study Canal Transportation* (µm) P MB DB * CM shift
  83. 85. (1) (2) (1) Peters et al, Int Endod J 2003, 36:86-92 (2) Metzger et al , on-going study Canal Straightening (%) P MB DB
  84. 86. SAF System Continuous Irrigation with Sodium Hypochlorite 5 A New Concept
  85. 87. Irrigator Attachment Hollow File
  86. 88. LCD Display Flow Control Buttons Foot Switch SAF System Irrigator VATEA ©
  87. 89. Irrigation Solution Reservoir 400 ml SAF Sytem Irrigator VATEA
  88. 90. Flow Rate 1-10 mL / min = 4 - 40 mL in 4 min
  89. 91. Positive Pressure Irrigation Negative Pressure Irrigation vs No-Pressure Irrigation
  90. 92. Will the solution flow beyond the apex ?
  91. 93. Rinsing efficacy : Transparent Blocks
  92. 95. Exchange of Irrigant
  93. 96. Rinsing Scrubbing
  94. 97. SAF System Continuous No-Pressure Irrigation with Activation & Scrubbing
  95. 98. Cleaning the root canal SEM Study
  96. 99. SAF Cleaning and shaping with NaOCl 3% alternating with EDTA 17% SEM
  97. 100. Smear Layer Scoring (Hülsmann 1997) Score 1 No smear layer, dentinal tubules open. Score 2 Small amount of smear layer, some dentinal tubules open. Score 3 Homogenous smear layer, only few dentinal tubules open. Score 4 Complete root canal covered, no open dentinal tubules. Score 5 Heavy, non homogenous smear layer covering the complete root canal wall. X 1000
  98. 101. Debris Scoring (Hülsmann 1997) Score 1 Clean root canal wall, few small debris particles. Score 2 Few small agglomerations of debris. Score 3 Many agglomerations of debris covering less than 50% of root canal wall. Score 4 More than 50% of root canal covered by debris. Score 5 Complete or nearly complete root canal wall covered by debris. X 200
  99. 102. Apical Mid-Root Coronal D75 X 500 Apical
  100. 103. Apical Mid-Root Coronal D75 X 200 Apical
  101. 104. Apical Mid-Root Coronal F48 X 1000 Apical
  102. 105. Canal Wall Free of Debris Coronal Third Middle Third Apical Third 20/20 100% 20/20 100% 20/20 100% Metzger et al, J Endod 36:697-702, 2010
  103. 106. Canal Wall Free of Smear Layer Coronal Third Middle Third Apical Third 20/20 100% 16/20 80% 13/20 65% Metzger et al, J Endod 36:697-702, 2010
  104. 107. SAF System High Durability : No File Separation 6 A New Concept
  105. 108. Torque Durability Separation after ~ 1.3 turns Rotary file
  106. 109. Torque Durability Separation after ~ 3.5 turns SAF
  107. 110. Mechanical Failure Patterns
  108. 111. Mechanical Failure Patterns
  109. 112. The SAF Procedure
  110. 113. The SAF Procedure <ul><li>Orifice funneled </li></ul><ul><li>Irrigating while working </li></ul><ul><li>One instrument ! </li></ul><ul><li>Path established up to # 20 </li></ul>
  111. 114. SAF – Benefits = H igher quality of treatment <ul><li>Improved cleaning </li></ul><ul><li>Improved irrigation </li></ul><ul><li>Improved sealing </li></ul><ul><li>Improved preservation of canal walls </li></ul>
  112. 115. SAF – Benefits <ul><li>A simple armamentarium </li></ul>
  113. 116. S 16/21 mm M 18/25 mm L 21/31 mm Ø 1.5 mm One File Per Procedure
  114. 117. SAF – Benefits <ul><li>A simple, easy procedure </li></ul><ul><li>= </li></ul><ul><li>Short learning curve </li></ul><ul><li>A simple armamentarium </li></ul>
  115. 118. SAF – Benefits <ul><li>A simple, easy procedure </li></ul><ul><li>A simple armamentarium </li></ul><ul><li>Improved Safety ! </li></ul>
  116. 119. <ul><li>Obturation </li></ul><ul><li>Methods </li></ul>
  117. 120. A New Method for Evaluation of Root Canal Filling– Dentin Contact by 3D Micro CT Analysis Resolution:17 µm
  118. 121. RCF- Dentin Contact – 98% Scan after Treatment + Scan after Obturation Yellow : touched by the RCF Red : un-touched by the RCF Resolution:17 µm
  119. 122. Tooth A22 - Lateral Compaction Bucco-lingual Mesio-distal
  120. 123. RCF / Dentin contact – 89.6% Tooth A22 - Lateral Compaction
  121. 124. Tooth A04 – Heated Gutta-Percha Injection Bucco-lingual Mesio-distal
  122. 125. RCF / Dentin contact – 98.6% Tooth A04 – Heated Gutta-Percha Injection
  123. 126. Bucco-lingual Mesio-distal Tooth A60 - Thermafil
  124. 127. RCF- Dentin Contact – 90% Tooth A60 - Thermafil
  125. 128. Obturation Study
  126. 129. Obturation Study % canal wall affected by the file Red: Area unaffected by the file
  127. 130. Obturation Study % canal wall touched by the root canal filling Yellow: Area untouched by the RCF
  128. 131. Figure 3 Correlation between % Unaffected Canal Wall and % untouched by RCF )
  129. 132. 2009: Clinical Trials
  130. 133. <ul><li>March 2010 </li></ul><ul><li>>250 </li></ul><ul><li>Clinical Cases </li></ul>
  131. 134. * * * * * * *
  132. 135. <ul><li>Conclusion </li></ul>
  133. 136. <ul><li>The SAF System </li></ul><ul><li>Represents </li></ul><ul><li>A Paradigm Shift </li></ul><ul><li>In </li></ul><ul><li>NiTi Instrumentation </li></ul>
  134. 137. Journal of Endodontics April 2010 The Self Adjusting File (SAF). Part 1: Respecting the Root Canal Anatomy A New Concept of Endodontic Files and Its Implementation Metzger Z, Teperovich E, Zary R, Cohen R, Hof R J Endod 36:679-690, 2010
  135. 138. Journal of Endodontics April 2010 The Self-Adjusting File. Part 2: Mechanical Analysis Hof R, Perevalov V, Eltanany M, Zary R, Metzger Z J Endod 36:691-696, 2010
  136. 139. Journal of Endodontics April 2010 The Self-Adjusting File (SAF). Part 3: Removal of Debris and Smear Layer A Scanning Electron Microscope Study Metzger Z, Teperovich E, Cohen R, Zary R, Paqué F, Hülsmann M J Endod 36:697-702, 2010
  137. 140. <ul><li>Thank You </li></ul><ul><li>Raviv Zary </li></ul><ul><li>[email_address] </li></ul>

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